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Plant Risk Assessment Template

This plant risk assessment addresses physical and health hazards that employees are prone to while performing their daily duties. Some of these hazards include the risk of entanglement, radiation poisoning, explosion, and dismemberment—to name a few. Depending on the type of plant and the nature of the work, certain risks are higher than others. Be prepared to handle any expected or unexpected dangers with this checklist, and keep your personnel safe.

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Plant Risk Assessment Template

Plant Information

Plant Name
Plant Type/Specialty
Plant Address
Supervisor Name & Title
Worker’s Name(s) & Title(s)
Plant Task Description
Frequency Rating (3-Daily/Frequently, 2-Monthly/Occasionally, 1-Quarterly/Rarely) Severity Rating (3-Fatality/Catastrophic Property Damage, 2-Lost Time Injury/Major Property Damage, 1-Medical Aid/Minor Property Damage) Probability Rating (3-Reasonably Probable, 2-Remote, 1-Extremely Remote)

Task Analysis

Task Description
Attach Photo of Hazard
Existing or Potential Hazards
Person(s) at Risk
Health and/or Safety
Type of Hazard
Priority Rating
Current Hazard Control Measures
Hazard Control Required or Improvement Recommended
Assigned To:


Additional Comments or Concerns
Additional Photos
Date & Time
Supervisor's Full Name & Signature
Employee(s) Full Name & Signature
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